Healthcare Provider Details

I. General information

NPI: 1689688749
Provider Name (Legal Business Name): ROBBIE J SOILEAU CRNA
Entity Type: Individual
Gender: Male
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 07/27/2006
Last Update Date: 02/12/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

241 AIMEE RD
FERRIDAY LA
71334-9615
US

IV. Provider business mailing address

12685 LILLY LN
DEVILLE LA
71328-9548
US

V. Phone/Fax

Practice location:
  • Phone: 318-757-6371
  • Fax: 318-757-7847
Mailing address:
  • Phone: 318-466-9169
  • Fax: 318-757-7847

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberAP04360
License Number StateLA
# 2
Primary TaxonomyN
Taxonomy Code367500000X
TaxonomyCertified Registered Nurse Anesthetist
License NumberR874174
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: